Louise King

Good evening, everyone. Welcome to our webinar on Cosmetics, my name is Louise and I'm your host this evening. Our expert presenters are Consultant Plastic Surgeon, Mr Chris Macdonald and Breast Care Nurse, Ali Holden Smith. As you can see on the screen, today's presentation will be followed by a Q&A session and if you'd like to ask a question during or after the presentation you can do so by the Q&A icon at the bottom of your screen, this can be done with or without giving your name. Please note, if you do provide your name, we do record these sessions so just to let you know. If you'd like to book a consultation to find out more, we'll provide a phone number at the end of this presentation and now I'll be handing it over to Mr Macdonald and you'll hear from me again shortly. Thank you very much.

Mr Macdonald

Thank you, Louise. Yeah, welcome along everybody, welcome to the Cosmetic Surgery webinar hosted through Benenden. So, I'm Chris Macdonald and you'll be hearing later on from Ali as well. So, this is kind of a taster really, I mean each of the things that I'm going to be discussing today could fill an hour or hours so it's going to be a bit of a ‘Whistle Stop Tour’ to just go through the sort of salient points. We'll talk a little bit about the basics of cosmetic surgery, and I’ll run through a few anatomical areas, so we'll talk about breast reduction surgery, abdominal surgery, upper arm surgery and some eyelid surgery as well. So just a little bit about myself, I'm a Consultant Plastic Surgeon, so I operate at Benenden but I'm also a Reconstructive Surgeon for the NHS where I work in East Grinstead and Brighton. So I went to medical school in London, I've been on Advanced fellowships for cosmetic surgery and reconstructive surgery, I'm a fellow of the Royal College of Surgeons for plastic surgery, I'm the council member for the British Association of Plastic Reconstructive and Aesthetic Surgeons for the Southeast and I'm a full member of the BID Association of Aesthetic Plastic Surgeons as well and then within those I sit on special interest groups for cosmetic surgery education and safety and surgery.

So, this is this might sound like a little patronizing thing to put in, but no one needs cosmetic surgery if you strictly think about it and what I always say to my patients it's very important that they come in to see me get something that's to improve the way that they feel about themselves and improve their quality of life. It shouldn't be something that anyone is doing for anybody else, so it's not something you should be doing to help a partner or to make anybody else feel better about your body. So, you know, what is cosmetic surgery? So, there's plastic surgery and there's cosmetic surgery and there's aesthetic surgery and there's quite a lot of terms that are thrown around and a lot of confusion and mismatch between the two of them and so to my mind cosmetic surgery is there to try and improve the way that you look and the way that you feel about that, because there's not always a direct correlation between those two and you can have someone who feels very unhappy about the way they look even though they're stunning and you can sometimes find that cosmetic surgery also involves functional improvements so in lots of the patients that we treat through Benenden they've had significant weight loss and one of the things that happens with weight loss is you could end up with excess skin and the excess skin can actually cause severe problems and it can be difficult to look after and you can get infections and you can even have problems where the skin starts to break down and you get ulcers and so improving all of those things or removing their skin can improve all of those things and it can really make a massive difference the way that someone feels about themselves. So, as well as that we also deal with the changes that come out as the ageing process through weight loss as I've already mentioned, whether that's as a result of bariatric surgery which is something like a gastric band or a gastric sleeve or whether it's through exercise and diet changes, there's also huge changes that go through your body as a result of pregnancy or multiple pregnancies that often lead people to come and see me as well so we won't be talking about anything to do with things that you're born with today.

So why is it that so many of the patients I see have come to me as a result of weight loss or pregnancy or ageing and actually in some ways all of those things share the same attributes, so weight loss and pregnancy and weight gain through ageing all create significant changes in volume and so as your body puts on weight and a fat increases in size it stretches the skin and then if you lose weight or if you deliver your baby, often people struggle to get the skin to retract back to where it was before and there are loads of different reasons for that. So, one is to do with the fibres in the skin being stretched beyond their elastic limits and they're never able to fully recover. Some of it is because of hormonal changes, both during pregnancy or during weight gain where the skin is made softer and it's never able to recover. We've seen what could change in people's nipples during all of those times. So, gravity is the enemy of a plastic surgeon, it's responsible for lots of the problems we see as well. So with the aging process and with weight changes we really see that the force of gravity pulls everything down and it might be that it's pulling your breasts lower on your body or it might be that's pulling all the anterior abdominal skin the skin from your belly further down all that is causing the excess skin and fats in your upper arms to be pulled down as well and as part of the aging process your skin becomes thinner and less elastic and it loses the ability to retract as well so we're going to start off talking about some breast surgery and which is the surgery that we've been doing the long list at Benenden and to think about that you think about what your sort of goals are for a breast and it's something that people often are aware of but aren't aware that they're aware of it if that makes sense so when people think about breasts they often think about them in terms of their size and most of the time people come and discuss breasts because they're unhappy with their size but actually there's a lot more to it than that and actually the most important bit is actually the shape so it's to do with where on your chest the breast is sitting so is it sitting higher on the chest or is it sitting lower on the chest and then size is important and then there's the quality of the skin that's over the top so is the skin thin and stretched and actually covered in stretch marks or is it or is it uninjured by all of the processes we've been talking about where are the nipples sitting on the front of the breast so if you can see this illustration here so the nipples are actually sitting at the most forward-facing past the breast which is what we normally see in teenagers and young women and then as time goes by the gravity the effects of gravity effects of Aging for the cause the nipple to fall forwards and actually the nipple effectively slides lower and lower down the front of the breast until it then sits in the lowest part and symmetry is a really important part of the cosmetic surgery that I perform so it's extremely uncommon for someone to have symmetrical breasts or breasts that are symmetrical in terms of all the things I've just talked about so either one is larger than the other or it's particular on the chest or the nipples don't sit at the same height and that's something that can often be improved with surgery as well so well this is just illustrating this similar sort of thing so where are you now and where would you like to get to and this is a classification named after a French surgeon that just talks you through the process where a breast slides lower and lower on the chest and the nipple Falls over there as well. We'll come back to that later on.

So, this is what you'd expect with a breast reduction type operation. We'll go through some actual before and after photos of patients who've been operated on in a minute, but this is demonstrating, I hope it's demonstrating that we've moved the entire footprint of the breast so that's where the breast is sitting on the chest from lower down where it's hanging off the body up highest was actually sitting closer it's been made smaller and the nipple's been lifted from low down on the breast to much higher up to where it belongs really and so that's these are the most common three things that we try and Achieve with the rest reduction operation and so this for breast reduction surgery we're really relying on patients to be looking for smaller breasts and because that makes the operation much easier it's much easier to make a breast smaller as you lift it but actually if you're happy with the size of your breast you don't necessarily have to have volume taken away and the breast tissue can instead be lifted and reshaped entirely so that if you like the size of your breast and you like the way that your breast fills your bra then actually don't necessarily have to have a reduction you can have what we call a breast lift or a breast or a master Pepsi where we can achieve the same lifting type operation and we can lift the nipple and we can rejuvenate the breast but we don't necessarily have to make anything smaller and depending on how far we're lifting the netball we need to do something to the excess skin that gets removed as well so there is something called a periareola incision so that's where you make a cut all the way around the areola at the breast that's only really suitable for very small breast reductions or very small amounts of breast lift so if you want to lift a nipple by about one and a half to two centimetres of the chest and you can do that through this sort of technique where you only leave a very small scar around the nipple and actually that blends in fantastically and becomes practically invisible after about 12 to 18 months but most of this patients I see they're not suitable for that kind of surgery and there's the vertical one so it's that combined with a scar that runs straight the way down underneath the breast and there's a small number of patients I see there two people for that and the vast majority of patients I see have very significant either reductions or very significant lifts and that leaves you with way too much skin at the end of the operation and the only way to remove all excess skin is with this anchor type incision so it's the same one we've already talked about but it then has a scar that runs all the way across underneath the breast in the fold where the breast meets your chest and actually that heals fantastically and it's a scar that pretty much disappears because the breast naturally drops slightly and covers it anyway so unless you have your hands above your head or you're resting flat on your back it's not a scar that anyone will ever see.

So, this is just talking through the exact way that we perform the last one I talked about the anchor scar so it's called a wise pattern named after a surgeon and wise pattern breast reduction and you can see that a is US planning out exactly what's going to be removed and you can see that leading towards nipple there's all those sorts of red lines and that's the blood supply nipple that needs to be kept in place so we free up the nipple and we lift it and we swing it up higher onto the chest and then all of the rest of the tissue that's there that's underneath the triangles that gets removed and sent away to be looked at under a microscope to make sure there's no cancers or anything that we weren't aware of and then the rest of the remaining breast tissue and skin is folded under and reshaped like a hammock underneath the breast to lift this up and then in the second illustration you can see exactly what we're talking about so the nipple gets lifted higher up onto the chest and the skin the breast tissue gets tightened and brought around so this is by far the most common type of breast reduction operation that I do and so these are just a few before and after photos we'll go through these sorts of patients so this is a fairly standard patient with very standard breasts to start with and very common goals so she wanted her breasts to be smaller the nipples to be lifted up and to be placed higher on the breast and you can see I think that's a pretty good result at the end of it as a sort of side of a requested side effect to the operation is that nipples tend to be made smaller during this and so as past the aging process or as a result of pregnancies most female breasts most female nipples tend to grow in size as well and actually shrinking them down can have a rejuvenating effect on a breast as well so this is a patient who has is similar but actually undergone a significant amount of weight loss as well so you can see there's a there's quite a long way from where the nipples were before to be lifted up afterwards and otherwise it's a very standard other result otherwise this these scars I would imagine were looking at scars at about six months and so at this stage you can still see the scar around the nipple with a little bit a little bit more red and slightly stands out but the Scarlet's running underneath the breast is starting to fade away quite nicely and the scars that sit underneath the breast actually you can't see at all.

So, this is a breast reduction in a younger patient so this operation is more difficult because the breast tissue only another patient is much harder and it's harder to shape and work with but the principles behind the operation are the same so patients like this often come and see me but sadly they're getting a lot of unwanted attention or more commonly they find it difficult to work out or you know and thought to get evolved in sports activities just because their breasts are carrying such a huge amount of weight on the front allows us to change the shape as well.

Another operation that we do at Benenden is to treat people who've got inverted nipples so this is a common problem actually and there are lots of different reasons behind why it happens sometimes people are born with it sometimes it's something that comes on later on in life and it's a fairly simple operation that can be performed under local anaesthetic it only takes about an hour but we just release everything underneath and allow the nipple to pop out again afterwards and it can make a big difference to the way that patients feel about themselves.

So, this is a patient testimonial from one of one the breast reduction patients at Benenden so I'm just going to start that this will just run for a couple of minutes giving you a patient experience.

[Patient testimonial video plays]

It's nice to hear that. That's fantastic. Right, so that's the end of our chat about breast reduction surgery and then I'm going to be running on to abdominoplasty surgery so that's the sort of the medical term for what everyone else calls a tummy tuck and it's a fairly confusing field this one actually because there's quite a lot of different options are available for patients and there's quite a lot of information that's out there but that's also mixed in with a lot of advertising material by surgeons who have invented their own operations or have renamed operations so they can Market them and there's lots of different terms for very similar operations so it's well we'll go through that in a minute but actually it's a bit of a Minefield when you start to try and do your own research into this but essentially the idea behind all of those is to try and tighten up all the skin in fact on the front of your belly and that can be combined with repairing a muscle gap which is a really common problem in either patients who've had significant weight loss weight gain and weight loss or inpatients who've had a single pregnancy or even multiple pregnancies where the six fat muscles the muscles that run up and down the front of your belly separates out and become wider and wider from each other and that has a couple of different impacts on them so it means that their core can become weak and it can mean that you can end up with back pain and there's lots of evidence that actually it can cause problems with your bowels or can worsen pelvic floor symptoms that can cause urinary incontinence and leaking and things like that and also as those muscles separate it allows all of the abdominal contents so your guts to bulge forwards and actually sometimes people come and see me seeking a tummy tuck and actually the whole problem is those muscles are separated and it's just all of their contents leaning forwards and causing evil just not because they've got any excess fat or skin at all so the repairing that is often an important part of the surgery it can be combined with liposuction so actually that's something we routinely do to give people the best possible results and actually like sucking around someone's flanks can really allow you to cinch in someone's weight and give them a really fantastic result and it can also be combined with other operations so you can have a tummy tuck at the same time as a breast lift or a breast reduction and which we'll talk about in a minute as well so this is what I've just been talking about so this is the muscle Gap or the diastasis recti which is the Latin term for it and essentially it's where those six different muscles have separated and it's most commonly as a result of a pregnancy but as I just said there's lots of other causes behind it and as those muscles separate everything that's in in your belly is no longer held there and all leans forward and so essentially we just need to put it all back together or what is an important thing to know about for abdominoplasty surgery is that so in this in this diagram so the muscles of your anterior abdominal wall which the six muscles we're talking about that's the pink Line running down the front of this illustrations belly and then the subcutaneous fats that's all the fatness between your skin and your muscles is the stuff that's in in blue and then what we call your visceral fats that's all the fat that's around all of your organs is in pink there and so all of the fat that's pink you cannot have removed with any form of surgery so there's no way that you can either reach that safely with liposuction or with an operation to go and take it away and so any fat that you've got around your organs needs to be removed through diet or exercise or bariatric surgery or something like that whereas it's a subcutaneous fat that's superficial so close to the surface compared to your muscles that's the stuff that we can get to so which leads me on to the next bit so how can you find out whether you're suitable for a tummy tuck type operation so if you were to lay on your back and look at the shape of your abdomen so if you lay on your back and your abdomen is still bulging forwards that usually means that it's because of all the facts that you've got around your organs and a tummy tuck isn't really the right thing for you at this time whereas if you lie fat on your back and you can you can pinch and hold your skin like that diet like the diagram showing you that actually all of that tissue that you're holding is something that can be removed with surgery in the form of a tummy tuck and that's the easiest way of knowing so this is a diagram demonstrating what I tend to call a traditional abdominoplasties this is some of the most standard technique that we use and you can see if you look at diagram number one there's a there it's been marked out and it's the diamonds that you can see there is essentially all of the skin and the fat that's going to be removed so during the operation we lift all that skin in a better way and we discard it and then actually underneath the skin of the front of your belly all the way up to your rib cage we free all of that skin up so that it can then be stretched down and then stitched together and your belly button so your belly button there's lots of talk about belly buttons with tummy tuck surgery but the belly button that you're left with at the end of it is still the same belly button you had at the start so we never detach it from your body we leave it there but we cut all the way around it which why there's a dotted line going around it in in the illustration number one here we go so you cut all the way around it and then pull all the skin over the top of it so this skin here gets pulled all the way down and then we re-fashion a new hole in the fresh skin that the skin here would have been the skin that used to be all the way up here that's been stretched down and then we make a hole and we pass the new belly button through it and stitches into place this leaves with a scar that runs all the way across low down there and a little scar around your belly button and so this is demonstrating you here the silhouette view so a combination of removing all of the skin and the fat that's on the front here as well as tightening up all those muscles and dealing with the Bulge then gives you a much flatter abdomen at the end of the operation.

So this is just going to run through so there's a few what I call the amazon policy scale so it goes from the smallest to the biggest so this is this is what we call a mini tuck so it's just a very small area from underneath your belly button that can be removed and stitched up together so there's very few patients that this is helpful for actually so this doesn't This only affects the skin underneath your belly button so if you did have excess skin here or a problematic caesarean SCAR or lots of stretch marks in this area then this is good for someone who's got that problem but actually if you've got any excess skin around the sides or any excess skin higher up here that's not helped with a mini tuck at all and so what you would need is exactly what I've just been talking about is that to traditional tummy tuck and then this is the next up so this then is something called a fleur-de-lis you can see the area of skin that we removed follows the fleur-de-lis pattern so we remove all of that skin and then tighten everything up and pull it down that's a much more powerful operation and we use that in patients who had really significant weight loss because it allows you to really pull everything around and make it much tighter and then the final one which is the sort of the most extreme version you can do is has again loads of names so some people call it a 360 tummy tuck or some call it a circumferential one or a belt like ectopy and essentially it means we're going to take away all of that red hashed red area but all the way around the patient so we go all the way around their back as well and so that does exactly all the things we've been talking about for your tummy but it also allows you to lift buttocks and tighten up the back as well and that's for patients who've had the most extreme amount of weight loss and these are the scars they leave you with so the first the first mini touch is a little tiny scar that runs all the way across that's commonly tucked away inside underwear the second one leaves you with a much longer scar so essentially it runs from the front of your hips the front of your hip but again is normally hidden by a bikini or by underwear but has the additional scar that runs around your belly button the fled gives you that but it's now combined with a scar that runs all the way up the front of your stomach the idea of an scar that runs all the way up like that actually puts a lot of patience off because there's no way they'd ever be able to hide that with a bikini or underwear but it's a much more powerful operation for really getting rid of lots of loose skin so it depends on what you'd accept to get the results you're after and final one is give it leaves you similar to my traditional one that I was talking about over here but the same scar runs all the way around all the way around the back of the patient so that's anything to know about that so here's a few before and after type photos so this is someone who's had a with a traditional abdominoplasty and you can see the scar has been tucked away inside her underwear so you can't see a stool and actually is the scarring the scarring from recreating the belly button can actually have a very good rejuvenating effect and make it smaller and Tighter and can change a very transverse so a very horizontal looking quite sad belly button into a much more youthful or athletic one so this patient here didn't have enough skin to pull this belly button all the way down so the belly button hole that was here has been pulled down to this this little tiny area here and then we just had to stitch it up so she has got a little tiny spectacle scar that's sitting here and so that's why I'm using this as a particular example if I will go back so that's demonstrating it from the side because if you look at the front you get lots of people look at this and say that she doesn't really need some tuck at all which I would agree with but actually let me sit from here you can see that she's got all this skin that's sitting here and overhanging her underwear and all the skin that's here that's been tightened up significantly so this is a patient who had a really significant muscle bulge so she had multiple pregnancies the cigarette muscles were sitting right around here and essentially what you're looking at here is all of the contents around them and leaning forwards and creating that so she has got excess skin that's here and that's all been removed as I've already described but the main problem here is actually the shaper abdomen so by removing that skin and tightening up all those muscles we've been able to give her much flatter absolutely and so these are a couple of other before and after demonstrating Arizona abdominoplasty in a in a slightly heavier patient so this is a sort of a more common result that we see and you can see here that this scar runs all the way from this patient's hip all the way to this patient's hip this is a nice mature and acceptable Scar and the belly button forms the shape as well what's kind of been cut off here is actually most tummy tucks actually rejuvenate the top of your thighs as well so as well as us pulling the skin of your belly down it ends up pulling the skin of your thighs up as well and the mons that's the area just where all your pubic areas actually that gets lifted as well as a part of an abdominoplasty and then similarly now that all this skin and fat has been removed from the front it's giving this patient a much better silhouette and as we pull the skin this way these creases and things that everyone has around the back here can get ironed out really nicely as well.

So, if you go on this wasn't put in intentionally because all the photos you see are patients who are sort of nicely healed and if you go spend much time on social media everyone goes on when they're sort of all healed up are beautiful and it's just demonstrating actually before you get to that phase you have to go through a phase where your body is trying to figure out what to do with all the extra fluid that's in it and everything else and this area here can become a little bit swollen and it's nothing it's all to panic about and actually, it can be dealt with by massaging it but essentially this will settle down nicely.

So, not all patients have abdominal plastic with liposuction but actually liposuction can even can further thin out the skin as well so that's what's been happening that's been done here so this patient had a traditional one so it's got our running from hip to hip scar on the belly button and then has also had abdominal as sorry excuse me it's also had liposuction to further thin out all the skin around here and actually highlight some of the muscles that's underneath as well so you can now get a hint of the edges of Essex muscles and this has been thinned out here as well and that's all due to the liposuction as combined with the tummy tuck there you go and again demonstrating that most underwear will hide a tummy tuck scale so this is a the fleur-de-lis this is the one I was talking about where you now have the vertical scar as well and this patient here could possibly have had a traditional abdominoplasty but all of this skin here would never really have been sufficiently tightened up so it would have been pulled down and this would all have been smoothed out nicely but to get such a good hourglass figure and a result from this she really needed the flow delete so these are the scars probably at sort of six to nine month phase here and so they're still a little bit pink but actually settling down really nicely I think that's a fairly good result and then again demonstrating the change in silhouette from the side.

So, this is someone who's had an extended I've done plasties it's all very similar except now this guy has come past the hip and this won't this is not a full circumferential one so it's gone all the way around but to give us a really good result and try and tighten everything over here we're just going further around so this has been combined with surgery on her breasts as well.

So, that's it there will be opportunities for questions in a minute but we're going to talk about brachioplasty so brachioplasty surgery follows all the similar sort of things so essentially it's an upper arm reduction or what people call a bingo Wing surgery so as a part of the aging process it's really common that people start to lay down fat in this area and it is a real problem because it's an area that is often out people see it when you're wearing t-shirts or vest stops whenever people wave their arms around or go to hug someone their skin in fact can swing and it really upsets all the patients I'll go through all of those things in a second so there's two real ways of tackling it so there's what we call the short scar I'm sorry I know I'm speeding up a little bit so there's what we call the short scar arm lift so this is really only suitable for people who have quite a small amount of excess skin about in this area so on the left here is the before and on the right is The Afters and so what you can see here is this skin that's all hanging down here and they come up into the armpits and so this can be tightened and pulled up so what we do is we open up the armpits here and remove quite a lot of skin from here and liposuck this whole area to thin it out and then pull all the skin upwards this way so you end up with a scar that tucks Away really nicely in your armpit here so it's a scar that isn't visible unless your arms are above 90 degrees and it does allow us to improve the shape and Contour of your arm here and it will give you a noticeable and good Improvement but it's quite a limited Improvement so there aren't very many patients I see that are suitable for this because most facials I see have got arms that are more along this size and actually we did a short scar one of this you would be really disappointed with the results so we would do a what I call a traditional brachioplasty so that's where we liposuck all of this skin all of the fat that's in here and empty this out and then do an operation to remove all of that excess skin and Stitch it back up again and so here so this is before and this is before and this is after and this is after and so you can see that essentially we've taken away or amputated all of that skin and fat there and giving this patient a much Slimmer arm Contour and you can see the scar here ends up running all the way from the armpit all the way it's down here or in some patients this actually sometimes we have to come slightly onto the chest so that scar actually runs from the chest and scarves all the way down.

You can choose where you want this car to be placed actually so this is another before and after and you can have the scar placed all the way down the inside of the arm here and so the advantage of that is that when your arm is against the side of your body like you normally stand then it's essentially hidden away and not something you'll ever see but if you ever reach out to hug someone or put your arms in front of you it can be quite a noticeable so although the scar will settle down really nicely and mature it will always be a permanent scar there it's something that people have to accept with brachioplasty surgery [Music] and then this is so this is an extended brachioplasty so actually this is where we someone who's got the heaviest amount of skin and fatness here as you can see this essentially joins onto the person's chest so there's no way of just removing this without taking this scar further onto the chest so it's exactly what we do so that's an extended brachioplasty and in some patients if you combine this with a breast reduction surgery you could have a scar that comes all the way across here all the way down there and that actually then joins the part of your breast reduction operation as well so that's that so eyelid surgery is something that we also perform at Bennington so this is something that's fantastic for people who are starting to feel the effects of age on their eyes and there's to the operated in your lower rated run through very similar processes but actually they're treated in quite significantly different ways so most of the patients come and see me who don't like their upper eyelids they normally complain about what we call hooding so it's just where all of this skin all of the skin that's here during the aging process just Falls lower and lower and lower and eventually it sits on your eyelashes and in the worst case it can actually start to close your eyes and actually it comes all the way across here sometimes we find patients who use the ability to see anything above this level and it's quite common for particularly men to bang their heads on things very commonly just because they've got too much skin blocking off their visual field people say that they get told they look tired or grumpy all the time and they're the reasons they've either come and see me and then the lower right lid people get bag formation so I mean I won't go over this too much because you'll know what this means but you get a bag the font here and during the aging process the skin becomes very thin and creepy you get lots of fine lines and wrinkles that start to cake make-up and cause problems and so they're both relatively easy to fix so for an upper eyelid it's going to speech and so up eyelids on their own can actually be treated very simply under local anaesthetic and essentially a cut is made all the way across like this small amounts of fat can be removed but actually normally the point of the operation isn't to remove huge amounts of fatness to remove all the excess skin that's there and to reposition the crease so where everything's falling forwards we can take away all the excess skin and give you a nice rejuvenated crease tucked away here for low riders this is normally done under shorts general anaesthetic but it's still done where you go home the same day and we place a scar all the way across like it's been demonstrating this picture here so the sky I use actually sits much lower under the eyelashes so it's normally something if it heals fantastically well they're not really aware of it and then we can remove some of the fat from your lower eyelid but actually it's normally due to the fat that's they're bulging forwards and creating a bag so part of the operation is to is to replay the fat or to red rape the fat to try and get rid of that bag and the shadow and everything else that you get there and to smooth out the Contour or the what we call the tear trough the groove that forms here with the aging process that's all part of a lower blepharoplasty operation and then we also remove any excess skin that's there so what do you expect during an operation like this so these are not my images these have been borrowed from an American surgeon and this is demonstrating how things look before so you can see all the skin here is sitting over here and hanging and creating a lateral Hood to a hood around the outside of the eye which catches the light and cast shadows and the patient doesn't like so you have day one so it's swollen because there's a combination of local anaesthetic and the patient's reaction to the operation and then you can see you normally have up to about two or three days of being quite swollen so these sorts of operations if we tend to try and do towards the end of the week by Monday the following week actually you could normally be on a virtual phone calls until that and nobody would know and then by the end of one week actually there's very few signs of swelling at all this patient here hasn't bruised at all but actually you can occasionally get a little areas of bruising and by one week normally you'd be fit to return to work and most people won't know if you've had anything done so these are some photos before and after is just running through so this is a really standard type of upper blepharoplasty patient so they've come and said I've got excess skin here it's resting on my lashes falling off to the side here and so you can have an operation to remove all of that lift everything up and recreate it and rejuvenate the eye there and the scar from this sort of surgery sits into that natural Groove that everyone has so actually it's pretty much invisible and this is a another exactly the same sort of operation where we're taking away all the excess skin and you can see here it's resting on those lashes and pushing them down and actually we've lifted it off and this is it's sort of a real art to trying to not take away too much because you can take away too much and if you take away either too much skin or too much fat in this area you can Hollow this out and actually hollowing this area out can actually have the opposite effect it can actually make it look older as well so it's real fine line to around to take away enough that you get a really good results and lift that skin away but without actually hollowing out the whole area so this here is combined with a camp pexy so this so camper pexy is where we tighten or move the angle of the eye as well so here you can see the skin has been taken away just like we've already been talking about but actually the lower eyelid has dropped away from the eyes slightly so here you can see white underneath the iris the eye here which is not a not something you want actually can be very aging so a little minor operation just to Hitch that up can really rejuvenate the eye as you can see here so what you don't want to see is this at rest I think that's a fantastic result.

So, this is so the upper capacity so exactly what I've been talking about before combined with the mid-faced lift so that's a little bit more than a lower bleph but not lower left of plasticity which is the low rider surgery but the not huge amount so essentially it's the same so it cuts across here underneath the eye which leaves you with a little scar that runs all across here and then we free up all of the fat that's in here and release that and allow it to fill this groove here and then lift the skin and fasten that area and so it leaves you with a loss of This Groove here so that's all been nicely smoothed out and nicely smoothed out and it has a fantastic rejuvenating effect.

So, this is so going through so upper and lower so both all four Lids so upper on both sides and lower both sides have been treated and you can see the improvements in everything but she has quite a significant asymmetry before and you can see the crease on this side isn't sitting in the normal place and she's also got a very mild degree of ptosis so this lid here is sitting lower than on the other side and so that can all be improved for the patient in the same operation and that's it so that's the end of what I wanted to talk about I I'm sorry that it was quite brief because all of those things have got huge amounts we could talk about but I hope I've gone through all the Salient points I'm going to hand over to Ali for a minute who's just going to talk to you about the pastry journey and if you were interested in the things you'd be talking about what you'd expect.

Ali Holden-Smith

Hi, so my name's Ali Holden-Smith, I'm the breast care nurse practitioner at Benenden so normally you're I'm the first person you'll have contact with potentially after you've rung our private patients team you might get a phone call from me I can't often give you a ring just to introduce myself so I can send you some information leave it and just give us a quick history before you come for your consultation this isn't always the case sometimes I do otherwise if it's quite a straight board operation then you'll probably just come straight to see Mr Macdonald so join your first consultation you'll normally see myself and Mr Macdonald or another cons consultant and we'll have some go for all your procedure what you come for some history and then we'll take some photographs just for your patient records just to see before and after your operations you may see some before and after pictures and then we'll like you to go away and have a think about it and decide if this is the operation for you we'd like to have at least a two-week on and off period before you come and see us again so at that point you either have a phone call with myself or a face-to-face consultation with the consultant where we'll go through anything else any questions you've thought about since you've gone away and read our patient information leave it and then we can book a date for you then you have a pre-assessment with me we'll go through what's expected on the day of surgery what you need to do lead not to surgery and if you need to stop or any medication in any medical history you need to see sometimes you may need to see the niche just as well just to make sure that we're all happy with that you're safe for surgery on the day of surgery you're coming to the hospital whether it's going to be a day surgery or an inpatient stay you'll come up to the wards and we'll see you on the day of surgery we'll do some marking and then we'll take some more photographs before you go down to surgery you'll go down surgery once you're back on the ward if it's a day surgery case you'll be back on the water a couple of hours you'll have something to eat and drink but we do like you to get up as quickly as possible for all the surgeries here because that really helps your recovery so we don't feel like you're lying in bed for all the time you're here once you're able a couple of hours at least after surgery get up and move around and then if it's a day surgery we'll discharge you once you're comfortable and if it's an overnight stay you'll go home sort of the next morning if you're comfortable and medically stable once you've been reviewed by myself I'm the surgeon and then you'll come back and see myself in clinic for wound check-ups and then you'll see the consultant again about six weeks after surgery but during that time there will be contact details of myself on the ward if you've got any questions then just give us a ring we'll be able to help you.

Louise King

Great, I think now I’ll take some questions. So, we have several questions I think the first we'll go to is a person who has said they've noticed sagging skin around their face and eyes, and this has happened as they've got older but there's also stretched skin to their earlobes. Could they be restored through surgery?

Mr Macdonald

The short answer is yes. It's probably not the sort of thing that I've been talking about so far so if you've got excess skin or soaking skin around your lower eyelid then that's what I have been talking about so that can be helped with a lower blepharoplasty if we talk about anything that's below that there's also anything below your cheek levels that normally needs to be treated either with a face slipped or with a neck lift which is not something that we currently offer at Benenden but there's stuff in the pipeline for that to be available hopefully next year but that's that that is something that's a really common plastic surgery operation and lifting it dealing with all the excess skin is a common past eating process and something that we see all the time sadly but yeah and particularly so if you're talking about the skin that you develop in the front of your ear here where it joins your neck that can all be removed as part of it that's a very straightforward thing to do.

Louise King

Great, thank you. Another question is chest reduction or breast reduction surgery is a possibility for men this person has lost some weight and their breasts are quite noticeable and embarrassing when wearing shirts for work.

Mr Macdonald

Okay yeah, so I'm sorry to hear that you feel that way, but I'm pleased that you've lost weight. So it so chest reduction surgery is something that we do offer at Benenden we do it for male patients it tends to be men who fall into two different categories so there are some men who've actually got some breast tissue and that's what we call gynecomastia there's lots of different reasons for why a man would have breast tissue and but that can be removed through a combination of open surgery so a little scar around the nipples take out that breast tissue and then liposuction to try and improve the contour of your chest and all the sort of thing that you're talking about so it's just where a man has got excess skin and it's something that we also deal with the scarring pattern is often different last night I was talking about for women where we try and avoid having the vertical scar that runs from the nipple down to underneath depending on how much skin you've got to remove or where your nipples are sitting there's lots of different ways of treating it but if I'm trying to think if there's any specific that you would want to know but it's something that's definitely available to you and if you're bothered about the way the chest is now then you should definitely go and see a plastic surgeon or come to see me in Benenden we can discuss the various options are available to you and yeah just because so the majority of my presentation was female based but we do offer this a similar surgery to men as well yes

Louise King

Thank you. Okay, the next question is a little lengthy so be patient with me this lady had two scans of skin cancer surgeries on her left cheek there were two years ago and it was redone 17 months ago there's quite a lot of skin that was taken from her which has had the effect of a kind of half facelift they want to have a small tuck on the right-hand side that's the left on the right-hand side of the face just in front of the ear to get rid of the line from the mouth to the gel that side and to even up the face they did consult a plastic surgeon about it but what he offered seemed to be extremely invasive involved two days in the hospital and it's also very expensive she doesn't think as much as that as suit necessary and she's just looking for a small talk and some filler like a mini facelift to even her up is this something that might be available.

Mr Macdonald

So then so the short answer would be not something that's available at Bennington but the long answer is that yes that you can have if you if this is the result of the skin cancer treatment you've had then you can have a mini type a mini type operation on the other side to try and improve the Symmetry and get rid of that line that you're describing which is a really common complaint so you can have surgery to lift all that I can imagine that so there's a trend in in face lifting surgery to go for what we call the deep plane facelifts that's where you get right underneath and really lift everything up and that gives you a fantastic result that will last you 10 to 15 years and so that's what lots passage offering at the moment and I think that's probably what you're describing because it is quite invasive and it means you have to stay in hospital and it's quite a lot to recover from but if what you're trying to do is you're trying to match somewhere where you've read a very minor operation then I think that would be overkill and I think so what you're talking about with a mini lift is probably really sensible so yeah unfortunately it starts at me we could offer you at Benenden but you could either bear with us until 2023 when hopefully we'll be something we can offer or I'm sure another good plastic surgeon will be able to help you with that.

Louise King

Thank you what is a realistic time scale for returning to work post-breast reduction?

Mr Macdonald

So that's a really good question and I think part of that Ali will have sort of touched on with it with her timings so you with a breast structure operation you're in hospital for one night you have dressings on for about two to three weeks it's really a fortnight before you can start doing anything so you can't really do any sort of work or anything strenuous around the house for fortnight so essentially that's your Baseline and then if you could return to doing some very basic office based work or working from home that doesn't involve manual handling or lifting or anything like that that actually after about fortnight you'd probably be feeling up to it and returning if you did have to do anything where you were shifting stuff around work or do anything where you are more active you're probably looking at about three to four weeks and if you actually had a physically demanding job you may well be looking at six weeks off before you're able to return yeah so I mean so we say if this is and after all the surgeries I've been talking about its six weeks before you can return to going to the gym or doing any heavy lifting or exertional work so it really depends on exactly what your job is but if you were working either at a computer or at a desk then I'd hope two to three weeks you'll be back to work great another kind of work related question that actually is in terms of if they were to have upper and lower eyelid lift when could they return to work and this person is a face-to-face as has a face-to-face role with customers in their job so it depends on what you mean by return to work so actually if so after 72 hours I wouldn't necessarily have an issue with you being at work but the results of the surgery would still be noticeable so if you could have an if you're working in sales or at a desk that actually are essentially hours you could technically be returning to work but I normally suggest a week off for it to really settle down to a degree where it's not obvious that you've just had surgery you're probably looking at a fortnight so if that if I think that's probably what the patient is trying to get at that you'll probably need a fortnight before you could go back into an office or back into a work environment without people noticing that you just had something done that's what I'd say.

Louise King

Great, thank you. Okay another question this person they've suffered quite a while due to loose skin from weight loss and as they've got older they've got particularly bad around their neck would you offer surgery to remove excess skin around the neck well that's an interesting question so it depends on where you meet so I'm so the place will be most commonly see it is this sort of area that hangs down here which I presume that's what they mean when they're talking about the neck and that's similar to what I was saying in minutes ago is that it's not currently part of the repertoire of surgery that we do offer at Benenden unfortunately so bear with us because as I've already hinted I'm hoping that will change but for the time being we're not seeing and treating patients for that problem but that's that would be in that would be what we call a neck lift and that is an operation that we commonly do just not that then yeah.

Louise King

Thank you. Just two more questions this person had weight loss surgery early last year at Benenden Hospital they're pleased but they have some excess skin as a result and they're considering surgery would she perform a tummy tuck and arm lift in the same procedure and is the recovery better to having this separately?

Mr Macdonald

Well I'm pleased to hear that everything went well with your care at Benenden so far yeah so combining surgery is often something that patients want to do and so you can combine a tummy tuck with upper arm surgery that's something that's definitely doable the your recovery so that why people often do it is it allows you to combine your recovery so rather than you having say six weeks off being able to you know do any heavy lifting and then six to nine months later doing the whole thing again actually you can combine it just have six weeks of recovery and then that's you done and dusted which is a really attractive way of looking at it but the only thing to bear in mind is that combining the surgery means that while you're recovering you're really very limited and so if you have surgery on your arms and surgery on your tummy at the same time even things like rolling over in bed or getting out of bed and getting dressed suddenly becomes quite significantly harder rather than only having one area that's been operated on so it's not necessary that you're more in more pain or anything like that it's just that working around two areas that are trying to heal and trying to recover is more difficult so you'd only really be able to do that if you did have quite a good support network at home or a partner or someone who'd be able to help look after you and arrange meals and or and all those sorts of things that go with it so if you did have a good support network and you think you'd be able to cope with being much more dependent on other people for a while the combining the operations would allow you to all in one and only have one recovery period yeah and that makes good sense.

Louise King

Okay thank you and the final question is from someone in their 30s they have some moles they find quite unsightly, and they like to have them removed is there something that we can provide?

Mr Macdonald

So yeah that is something that we do at Benenden yes I don't treat so if there was anything that you thought was possibly cancerous that's not something that I tend to do abundantly but if they're moles you don't like the look of then you feel free to call up and book in and come and see me and we can take care of that yeah that's sort of minor local anaesthetic operations that's very straightforward for patients.

Louise King

Excellent, thank you.

Okay, so that's all of our questions and if you do have any afterwards, please feel free to email the email address on the screen and we can help you. If you'd like to book a consultation, please contact us at the number on the screen. Sarah from our Private Patients team will be ready to take your calls until 8 PM this evening and alternatively, the team are available 8 am to 6 pm Monday to Friday. As you'll see on the screen, we are offering a discount on this session with the terms on the screen, so it's 50% off your initial consultation. Once we've finished this webinar there'll be a short survey and I'd be grateful if you could spare a few minutes to let us have your feedback it helps improve future events and our next event is in two weeks and it's on the treatment options for hip and knee arthritis.

So, on behalf of myself and today's presenters and the team at Benenden Hospital, I'd like to say thank you very much for joining us today and we hope to hear from you soon. Thank you very much and goodbye.